Q: Does knuckle popping lead to arthritis? Evidence-based answer: No, habitual knuckle popping, or cracking (over the course of several decades) isn't associated with clinical or radiographic evidence of osteoarthritis (strength of recommendation...

Q: Does caffeine intake during pregnancy affect birth weight? Evidence-based answer: No. Reducing caffeinated coffee consumption by 180 mg of caffeine (the equivalent of 2 cups) per day after 16 weeks-gestation doesn't affect birth weight. Consuming...

Monitoring home BP readings just got easier. This novel method of identifying patients with uncontrolled hypertension correlates well with ambulatory BP monitoring. Practice changer: Use this easy "3 out of 10 rule" to quickly sift through home...

A more palatable alternative to oral rehydration therapy for kids. Parents no longer need to struggle to get their kids to drink electrolyte solutions during episodes of mild gastroenteritis; apple juice works just as well. Practice changer...

Favorable results from the 2 studies reviewed here have prompted ACOG to recommend that cell-free DNA screening be discussed with all pregnant patients. Practice changer: Discuss cell-free DNA testing when offering fetal aneuploidy screening...

Kidney stones? It's time to rethink those meds. Despite being recommended for ureteral stone expulsion, tamsulosin or nifedipine are no more effective than placebo. Practice changer: Do not prescribe tamsulosin or nifedipine for stone expulsion...

"Go low" or say "No" to aggressive systolic BP goals? The SPRINT trial demonstrated the benefits -- and risks -- of reaching a systolic target <120 mm Hg in non-diabetic patients at high risk for CV events. Here's who might benefit. Practice changer...

More isn't better with acute low back pain treatment Adding cyclobenzaprine or oxycodone/acetaminophen to naproxen for the treatment of acute low back pain does nothing more than increase adverse effects. Practice changer: Consider treating patients...

Light therapy for nonseasonal major depressive disorder? While bright light therapy already has a place in the treatment of seasonal affective disorder, a recent trial spotlights its utility beyond the winter months. Practice changer: Consider...

Resistant hypertension? Time to consider this fourth-line drug For most adults with resistant hypertension, spironolactone is superior to doxazosin and bisoprolol as an adjunct to triple therapy. Practice changer: When a triple regimen of an ACE...

Deliver or wait with late preterm membrane rupture? While ACOG recommends delivery for all women with ruptured membranes after 34 weeks' gestation, a new study finds expectant management may be the way to go. Practice changer: In the absence...

On-demand pill protocol protects against HIV: Finally, there's an effective prevention strategy -- other than condoms -- that can be used, as needed, by patients at high risk for HIV infection. Practice changer: Offer patients at high risk for human...

Yeast infection in pregnancy? Think twice about fluconazole. This study's findings regarding the risk of miscarriage may mean it's time to forego fluconazole in favor of topical azoles as first-line treatment. Practice changer: Avoid prescribing...

with each other. Three SSRI antidepressant medications--fluoxetine, sertraline, and escitalopram--produce modest improvements (about 5% to 10%) in standardized depression scores without a significant increase in the risk of suicide-related outcomes (suicidal...

[SOR]: C, post-hoc analysis of a randomized controlled trial [RCT]). Intensive lifestyle modification reduces absolute risk in all patients proportionate to risk quartile (from 5% reduction for the lowest quartile to 28% for the highest). Over a 10-year...

Q: How do clinical prediction rules compare with joint fluid analysis in diagnosing gout? Evidence-based answer: Clinical prediction rules effectively diagnose gout without joint fluid analysis. The American College of ...

Q: Is lower BP worth it in higher-risk patients with diabetes or coronary disease? Evidence-based answer: There is no simple answer; the risk/benefit picture is complicated. Controlling blood pressure to a target of 130/80 ...

Tamsulosin for patients with ureteral stones? Yes, but only for some. Find out which of your patients can benefit. PRACTICE CHANGER: Prescribe tamsulosin for stone expulsion in patients with distal ureteral stones 5 to 10 mm in size....

Q: Which nonhormonal treatments are effective for hot flashes? Evidence-based answer: Selective serotonin reuptake inhibitors (SSRIs [fluoxetine, sertraline, paroxetine]) and the selective norepinephrine reuptake inhibitor ...

injection for as long as 10 weeks, but the 80-mg dose reduces progression to surgery at one year (SOR: B, RCT). Long-term effects of injections decrease by 12 months (SOR: B, RCT). After corticosteroid injections, 14% of patients proceed to surgery at one...